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Laryngeal cancer is the third most common form of head- and neck cancer and each year approximately 175 people receive the diagnosis in Sweden. Radiotherapy is a common treatment against laryngeal cancer. This is a retrospective cohort study, and it has investigated how swallowing, voice function and nutritional status can be affected by radiotherapy. The aim of the study was to explore whether there is a correlation between the grade of tumor and swallowing after treatment and when swallowing and voice function recover. The aim was also to research how many patients received contact with a speech- and language pathologist before or during treatment. The following study included 52 patients with laryngeal cancer (C.32) within the region of Gävleborg, Sweden. The results indicate that radiotherapy affects swallowing, voice function, and nutritional status. By the end of treatment, 24 of 48 patients had signs of dysphagia and voice function was affected in 33 of 52 patients. An increase in the need for nutritional drinks was noted throughout radiotherapy and 24 of 37 patients lost weight during or after treatment, which indicates nutritional difficulties. At the end of the treatment, 7 of 52 patients needed enteral nutrition. In total, 33 of 52 patients were offered contact with a speech- and language pathologist. Recovery of the swallowing function was reported in 22 of 39 patients at some point during the first year after radiotherapy. Recovery of voice function was reported in 8 of 40 patients at some point during five years after radiotherapy. The results of the study indicates possible implications that radiotherapy might have on vital functions, and it can suffice as a basis for further prospective studies within the area of head- and neck cancer.

It is important to have good language skills and a broad vocabulary for knowledge acquisition and communication. Today, there are high demands on language comprehension, which includes the understanding of metaphors. Metaphors are one type of figurative language whose interpretation is not literal. Therefore, more knowledge about figurative language in the group of teenagers and young adults with cochlear implant (CI) is needed. The aim of the study was to investigate metaphor knowledge in Swedish - speaking teenagers and young adults with CI in relation to implantation age of the first CI (CI1), expressive vocabulary and pragmatic ability. The study included 17 participants with CI between the ages of 12 and 20 years. They were recruited by the Hearing Implant Clinic, Karolinska University Hospital. Sixteen participants had bilateral CI and one had bimodal hearing (one CI and one hearing aid). The average age at CI1 was 15 months. Participants' metaphor knowledge was assessed using a Norwegian metaphor task translated to Swedish, expressive vocabulary with the Boston Naming Test (BNT), and pragmatic ability with a parent questionnaire (CCC-2). The participants' motivations in the metaphor task were transcribed and analyzed using a qualitative response analysis. The results showed that young people with CI exhibits metaphor understanding. However, it varies within the group regarding the number of correctly selected responses. Further findings indicate that there is a moderate negative statistically significant relationship between age at CI1 and the results of the metaphor task. One conclusion is that there is a large variation regarding metaphor knowledge within the group of teenagers and young adults with CI. The qualitative analysis shows a high degree of discrepancy between the choice of correct answer option and insufficient or incorrect justification of the given answer. Early age at CI1 appears to have a beneficial effect on higher language abilities such as metaphor knowledge. However, further studies are needed, preferable in larger cohorts and with a hearing control group. 

Purpose: Adults born with intellectual disabilities (ID) and motor disabilities (MD) have higher risk of dysphagia and should be assessed to decrease risk of severe complications. However, standardised assessment tools in Swedish are lacking.

Methods: The Dysphagia Assessment Package (DAP) was cross-culturally translated from English to Swedish (DAP-SE) and tested for content validity by an expert group. Face validity was assessed by five speech and language therapist (SLT) during meal observations (n = 10), and the clinical relevance was reported in a study-specific questionnaire.

Results: The DAP-SE was culturally adapted within the process of translation and was found to contain clinically relevant aspects to assess and suggest further interventions for adults with ID and MD. Face and content validity was confirmed by the expert group.

Conclusion: This study, in which the DAP-SE was tested in a small sample size, provides the first indications of the instrument's validity with respect to evaluating mealtimes, swallowing function and swallowing safety in adults born with ID and MD. The study adds to the knowledge on how to translate and culturally adapt an assessment tool to clinically assess dysphagia on a complex and vulnerable patient group.

A primary symptom of developmental dyslexia is difficulties with word decoding. To be diagnosed with developmental dyslexia, a thorough investigation is required. This investigation includes direct tests of the child ́s reading and writing abilities, as well as anamnestic information from the child itself, the child ́s guardians, and the child ́s teacher. One way of obtaining information from guardians while investigating a child ́s behavioral and developmental difficulties can be through parent questionnaires. The 5- 15 (“Five to Fifteen”) parent questionnaire is designed to capture symptoms of ADHD (Attention Deficit Hyperactivity Disorder) and common co-occurring conditions, such as reading and writing difficulties. While the 5-15 questionnaire has demonstrated good validity and reliability for capturing ADHD symptoms, its usefulness for detecting reading and writing difficulties has not been previously investigated. The purpose of this study was to examine whether there is a correlation between how guardians rate their child’s reading and writing ability in the 5-15 and the child’s performance on direct reading and writing tests. A total of 64 children between the ages of 9-13 participated in the study. These children were divided into two groups where one group consisted of children with a dyslexia diagnosis (n=30) and one group consisted of children without reading and writing difficulties (n=34). The results showed a strong correlation, across all children, between reading and writing rating scores on the 5-15 and the scores on direct reading and writing tests. However, when analogous analyses were conducted within the two groups separately, no correlations were observed between rating scores and scores on direct tests. In summary, 5-15 appears to be useful in distinguishing children with significant reading- and writing difficulties from those without reading and writing difficulties. However, the questionnaire does not seem to be useful in differentiating the degree of reading and writing ability within these two groups. Future research should examine whether the results hold in a larger sample of undiagnosed children with varying reading abilities. 

Within Swedish child health care, language screening should be carried out at the age of 2.5–3 years. Based on the outcome of the language screening, further interventions are offered based on guidelines found in the National Child Health Handbook. The purpose of the study was to investigate how many children, based on the language screening at the Child health center (CHC) at the age of 2.5–3 years, have a language screening result with deviation, if these children are referred and if there are regional differences or differences between different language screening methods. The purpose of the study is also to investigate at what age children are referred to a speech language pathologist in connection with visits to CHC based on region and language screening method. To answer the purpose of the study, five questions were formulated. The study's data were taken from the quality register Swedish Child Health Care Register (BHVQ) with data registered from visits to a CHC. The data used came from five regions and there were a total of 28,906 participants.

The study's results showed differences between the regions and the language screening methods within some of the study's questions. There were no distinct differences in terms of the age at language screening. However, there was a clear difference based on the percentage of children who participate in a language screening, which could be explained by insufficiencies in the keeping of the medical records. There was a distinct difference in the proportion of children who were referred to a speech language pathologist in connection with the language screening. Between the regions there were distinct differences in remittance and non-remittance in case of a positive outcome on the language screening, these differences were not seen between the language screening methods. There were differences in age for referral to a speech language pathologist from the CHC. It thus emerged that the methods and guidelines that existed were not followed to the full extent in the regions included in the study. There were factors in the study's data, such as differences in the number of participants in different regions and record-keeping deficiencies, which affected the results to some extent, and they need to be viewed with caution. Further studies are needed to be able to draw larger conclusions based on the study's results.

Phonological awareness and expressive vocabulary are important aspects of children's language development. Previous studies have investigated the relationship between phonological awareness and expressive vocabulary, but it has been difficult to determine the nature of the relationship. The purpose of this study is to investigate the relationship between phonological awareness and expressive vocabulary in second grade children. The study also examines whether there are gender differences in test results. The relationship between phonological awareness and expressive vocabulary is tested with subtest from IDS-2 (Intelligence and Development Scale - 2nd Edition) and the picture naming test Nomine. Participants were 50 children in the second grade. The participants were tested with subtasks from the IDS-2 that examine the ability to clap syllables, perceive rhymes, name the first and last sounds in words, and name all sounds in words. Expressive vocabulary was tested with the Nomine. Correlation analysis with Spearman's rho was performed to measure the relationship between phonological awareness and expressive vocabulary. The results showed no correlation between phonological awareness and expressive vocabulary. Gender differences were shown in the total score of phonological awareness from the IDS-2 and in the task of clapping syllables from the IDS-2. The present study also contributed to the collection of data for the standardization of IDS-2.

Aphasia does not only affect the individual with aphasia, but also has significant consequences for the significant others' daily life, health, and quality of life. It is therefore essential to investigate the significant other's experiences of support and current needs, to ensure they receive adequate resources to manage their altered life situation. The study aimed to examine significant others' experiences and needs regarding support from healthcare and society, as well as to analyze potential changes since the previous study in 2012. A survey containing both closed and open-ended questions on their experiences, needs, and satisfaction with the support received was completed by 60 significant others of people with aphasia. The results revealed several shortcomings, such as insufficient coordination between different actors, lack of follow-up, and limited information about available services. At the same time, many expressed satisfaction with the support they had actually received. A comparison with previous study from 2012 showed few differences, suggesting that significant others' experiences and need of support from healthcare and society have not changed substantially over time. The study highlights the need for improved coordination and accessibility of support services to better address the needs of significant others.

Dyslexia is a disability that primarily involves difficulties with decoding in reading. Previous research suggests that individuals diagnosed with dyslexia often also exhibit symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Between 25 to 40 percent of all individuals with dyslexia or ADHD also meet the criteria for the other diagnosis. Previous studies, with a focus on English-speaking individuals, have shown that the comorbidity between dyslexia and ADHD, above all, manifests itself in difficulties between attention and reading. In contrast, the relationship between impulsivity/hyperactivity and reading is weaker. This study examines whether the same patterns of connections between reading and ADHD symptoms such as attention and impulsivity/hyperactivity can be found in a group of Swedish-speaking children. By analyzing a parental questionnaire called 5-15, where parents of children with and without dyslexia estimate their children’s ADHD symptoms divided by degree of attention and impulsivity/hyperactivity, conclusions can be drawn about the examined group. The study found that parents of children with dyslexia estimated their children’s total symptoms of ADHD higher compared to parents of children without dyslexia. In addition, the connection between attention and impulsivity/hyperactivity scores in the parental questionnaire and a direct test of children's decoding is also analyzed. The study shows moderate relationship between attention and the children’s decoding, while the result of impulsivity/hyperactivity and decoding was weak. The results reflect the patterns observed in previous international studies. Future studies with a bigger sample size and normal distributed data are needed to examine whether the difference in the strength of the correlation is statistically significant.

Background and aims: Significant others (SOs) of people with aphasia (PWA) can affect the individual’s social participation, conversational ability, and rehabilitation outcome [1]. SOs have been called the most valuable but also the most vulnerable resource of a patient [2]. To be a supportive SO and to remain healthy in a challenging situation SOs may need support themselves. The aim of this study was to investigate what support SOs of PWA have received, how they experienced the support, and their need for further support. 

Methods: 173 SOs responded to a study-specific questionnaire (response rate: 67.8%). Quantitative data were analysed with descriptive and comparative statistics and answers to open-ended questions were analysed with qualitative content analysis. 

Results and main contribution: The SOs appreciated knowledge, devotion, helpfulness, and empathy of health care staff and community services. Community services were perceived as being characterised by long processing times, lack of continuity of staff and insufficient understanding of the needs of the PWA and the SO. Most respondents were satisfied with the informal support provided by disability organizations, family, and relatives. There was however still a pronounced need of a more understanding environment (family, friends, health-care services). The strongest need expressed by the SOs was having time of their own. Despite an acknowledged burdensome situation and low emotional well-being among SOs of PWA [3], the need for counselling was the least perceived need (expressed by 16%).

Conclusions: Feeling seen and acknowledged as well as having time of their own are important but perhaps underestimated needs of SOs of PWA. 

Implications: This study highlights the importance to include the SOs in the rehabilitation of PWA but also to provide separate support to them.

Det är välkänt att anhöriga till personer med afasi kan må dåligt på olika sätt. Men hur vanligt är det med psykisk ohälsa? En ny forskningsstudie har tittat på det.

Why do significant others of people with aphasia accept or decline participation in communication partner training? A pilot study

Background and aims: Communication partner training (CPT) is an evidence-based aphasia intervention that is strongly recommended in Swedish clinical guidelines for stroke care [1]. However, clinicians report that many significant others (SOs) decline participation [2]. There is limited research on the SOs’ perspectives and experiences of CPT, especially regarding the factors that could make them decline the training. This study aims to explore why SOs accept or decline CPT in Sweden, and what factors influence the decision to participate or not.

Methods: Interviews with four SOs who had been offered CPT, two of which had completed CPT and two that had declined participation. The interviews were analysed using qualitative content analysis.

Results and main contribution: Reasons for not taking part were Practical barriers (long distances, training during work hours, own health problems) and Doubtful to effect of CPT (communication is already working well, too severe aphasia). Factors which could affect the decision were Time when CPT was offered (time post-onset of aphasia, recurring offers during rehabilitation), Experiences of earlier aphasia therapy, Perception of the speech-language pathologist (SLP), and How CPT was introduced.

Conclusions: The decision to accept or decline CPT is affected by several factors, not only practical issues. However, to better understand the SOs’ perspectives and experiences of CPT, future studies with larger samples are needed.Implications: Although being a pilot study with few participants, the result contributes with insights of the importance of a good relationship with the SLP and trust in his/her competence in addition to how CPT is presented.

References:

1. National Board of Health and Welfare. (2020). Nationella riktlinjer för vård vid stroke: stöd för styrning och ledning. Socialstyrelsens publikationsservice. https://www.socialstyrelsen. se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2020-1-6545.pdf

2. Persson, K. J. et al. (2022). Do best practice recommendations align with current aphasia practices in the Swedish care context: a national survey. Aphasiology, 36(8), 903–920. doi:10.1080/02687038.2021.1917504

Previous research has found that there is a correlation between executive functions (EF) and language skills in people with different diagnoses such as specific language impairment, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) but few have explored this correlation from a dimensional perspective. The purpose of this study was to examine potential correlations between EF and language skills as a continuous, rather then categorical, variable in children (grade 1-2). Is there a correlation? If so, is the nature of the correlation stronger between EF and some specific aspects of language skills? Are there any differences in the potential correlations between the legal genders girl and boy? This was examined via the responses that caregivers gave in the parental questionnaires CCC-2 (the Child Communication Checklist, Second edition) and 5-15 (Questionnaire for Evaluation of Development and Behaviour, parent questionnaire) for 23 participants (14 girls and 9 boys). The results showed a moderately strong correlation between EF and language skills. The strongest correlation was between EF and pragmatic language skills, especially the skills "initiative" and "coherence". No sex differences were observed in this study. This is in line with previous studies but further research with more participants is needed for more reliable results.  

Approximately 7000–10000 people per year acquire aphasia in Sweden. Aphasia occurs after an acquired focal brain injury, commonly associated with stroke. People with aphasia have difficulties with language and speech. Mental health problems are commonly occurring after stroke and aphasia, often in the form of depression and anxiety. People with post-stroke aphasia have a higher prevalence of depression and anxiety compared to stroke patients without aphasia. International studies in this field show failures in the care of mental health in people with aphasia, for example in different professions responsibilities and competence in the subject. The purpose of this qualitative interview study was to investigate Swedish speech-language pathologists (SLPs) experiences of patients with aphasia and mental health problems, and SLPs view of the healthcare’s management of these patients. Six SLPs within different parts of the rehabilitation pathway and experience in rehabilitation where interviewed. The interviews were conducted through Zoom or at the participant’s workplace. The interview was analyzed with a qualitative content analysis which resulted in 18 categories. The SLPs experiences of the mental health in patients with aphasia were about the role SLPs have in meeting and taking care of this patient group. Even though without formal education in strategies for taking care of mental health problems the SLPs used their education, strategies and tools to be able to take care of the patient’s mental health problems. SLPs experiences also gave an insight to how the mental health problems manifested in patients and what causes it. The SLPs saw several deficits in the health care management of these problems, for example limited access to the psychiatry when having aphasia and lack of knowledge of aphasia and how to handle someone with mental health problems. Teamwork was seen as essential by all SLPs to accommodate the patient’s needs. The results may contain important information about how mental health problems can be detected and handled if the patient has aphasia. The deficits that are being presented can be used to improve the care of this patient group. Continued research in this field is needed. 

Purpose:The aim of this study was to explore the path to Listening and Spoken Language Specialist (LSLS) certification from the professional's viewpoint as well as to address motivation, self-perceived gains, challenges, and barriers to certification in an international cohort with the purpose of guiding future change within the existing certification system.

Method:Members of the AG Bell Academy for Listening and Spoken Language (AG Bell Academy) Global Matters Committee created an online survey disseminated by the AG Bell Academy in English and Spanish for professionals who were certified LSLSs, mentees currently pursuing the certification, and professionals interested in the certification. Participants (N = 295) were from different parts of the world. Of the respondents, 48% reported English as their first language, 19% reported Spanish as their first language, and the remaining 33% reported one of 26 other languages as their first language. Approximately 40% of the total respondents were certified LSLSs (n = 117), and 50% of them lived in the United States.

Results:The findings indicate that certified LSLSs perceived significant growth in knowledge and skills as a result of the certification process. Personal motivation drove individuals to pursue certification. A common barrier among all participants was limited resources, such as time, funds, and access to a mentor who speaks the same language.

Conclusions:There is a need for more awareness of the significant gains LSLS certification can bring to professionals. There is further need to address, minimize, and overcome perceived barriers in the process. Future similar research is warranted to explore the gains and barriers of obtaining the LSLS certification outside the English-speaking countries and in a larger, more population-based sample.

The two most common tumour localizations in head and neck cancer patients are in the oral cavity and oropharynx, with 500 cases each per year. Hypopharynx cancer is rarer with approximately 60 cases per year. Radiotherapy is often used as a treatment for cancer in the oral cavity and pharynx. The aim of this study is to broaden the knowledge of the long-term effects of radiation treatment in the oral cavity and pharynx. This is a retrospective longitudinal study that examines swallowing function through the functional oral intake scale (FOIS), nutritional intake and communication in 91 people with oropharyngeal cancer. This study also investigated the duration of the participants´contact with oncology-related healthcare, as well as to what extent the patients were offered therapy with a speech language pathologist (SLP) and for how long. The result of the study shows that the swallowing function is affected to a high degree by radiotherapy and communication is affected to a certain extent. At the termination of radiotherapy, 90,1 % participants had affected swallowing, which was classified as dysphagia (swallowing difficulties). The need for nutritional drink was the greatest at the end of the radiotherapy. Gastrostomy was reported in 21,9 % participants, 10 % of these participants were successfully weaned from their gastrostomy. Voice function was reported affected in 17,5 % participants and speech function was reported affected in 38,8 % participants. Therapy with SLP was offered to 55 % of the participants. Between the time period 25 to 60 months 40 % of the participants had regained their swallowing function, and the greatest recovery was seen in the participants who had cancer in the base of the tongue. The result of the study will contribute to improving the conditions for rehabilitation for patients due to oropharyngeal dysphagia in cancer of the oral cavity and pharynx after radiotherapy. 

Objectives: The main goal of this study was to describe the expressive vocabulary of school-age children with mild to moderately severe hearing loss (CHL group) and to compare their performance with children with normal hearing (CNH group) of the same age. Another aim was to examine the interaction between nonword repetition and expressive vocabulary size. Furthermore, the interaction between results on vocabulary tests and background factors, such as the age of diagnosis, age of hearing aid fitting, and amount of hearing aid use, was explored. 

Method: School-aged children with mild to moderately severe, permanent bilateral hearing loss and children with normal hearing were included in this cross-sectional study. The children participated in assessments of naming pictures, defining words, and repetition of nonwords and sentences. Results of the CHL group and the CNH group were compared. The analysis also included the degree of hearing loss, the age of diagnosis, amount of hearing aid use, and level of parental education. 

Results: The CHL group performed significantly below the CNH group on all measures: picture naming, defining words, nonword repetition, and repetition of sentences. The proportion of words pronounced with correct phonological structure when picture naming was more limited in the CHL group than in the CNH group. There was a significant positive correlation between the amount of hearing aid use and nonword repetition ability in the CHL group. Age of diagnosis and age of hearing aid fitting was not significantly correlated with the outcomes of the vocabulary assessments in this study.

Conclusion: Despite the technological advancement of hearing aids, the expressive vocabulary in school-aged children with mild to moderately severe, permanent bilateral, hearing impairment does not reach the same level as for children with normal hearing, although there is a variation in performance within the group. The variation in the CHL group was not uniquely impacted by either age, degree of hearing loss, or the age of diagnosis. The amount of hearing aid use seems to impact the perception of new words. More studies of expressive vocabulary are needed, because they capture a dimension of word learning that seems particularly sensitive to hearing loss and hearing aid use.

Vocabulary and decoding are both important for reading comprehension. Reading comprehension is important for academic skills as well as workplace success. The expressive vocabulary contains the words that can be produced. Decoding is the foundation of reading and constitutes making connections between letters and sounds. Previous research has found correlations between expressive vocabulary and decoding of words and nonwords.  The majority of investigates receptive vocabulary, the words that are understood, rather than expressive vocabulary in relation to decoding. Research indicates, however, that expressive vocabulary might be a more accurate way of measuring the vocabulary.

The aim of this study was to investigate how children in second grade perform on a newly constructed picture naming test, and on the standardized test LäSt which assesses decoding skills of words and nonwords. Correlations between expressive vocabulary (through picture naming) and decoding of words and nonwords were also explored. An additional purpose with the study was to collect data for an upcoming standardization of the new Swedish picture naming test. The study consisted of 39 participants in second grade, 21 boys and 18 girls. Each participant completed the picture naming test and the tests of decoding of words and nonwords from LäSt in one individual session. The results showed that there were positive correlations between expressive vocabulary and decoding of nonwords and words. The correlation for nonwords was the strongest. The results partially confirm previous research findings. More research is needed to understand how and why these abilities correlate.